Reactive Hypoglycemia: a cautionary tale

For many individuals, shedding a lot of weight leads to blood glucose (BG) ranges at or near regular, and your physician might let you know that you simply’re now not diabetic. If this occurs to you, to begin with you need to be congratulated for the troublesome job of reducing weight. That’s fantastic.

But you also needs to be vigilant to be sure you do not get reactive hypoglycemia, which suggests very low BG ranges after you’ve got eaten a lot of carbohydrate. This can occur even once you’re not diabetic.

I had reactive hypoglycemia about 20 years earlier than I received the diabetes analysis. At the time, I used to be a night time owl and hated getting up early within the morning. But sometimes, on the each day newspaper the place I labored, I needed to do the “wire desk,” which meant arriving at 7 am. Because I hated it a lot, I might deal with myself to a chocolate doughnut. Usually I did not eat breakfast in any respect.

Then at virtually precisely four hours after the doughnut and black espresso, I might get the shakes and really feel as if I might die if I did not eat one thing. In truth, I might virtually set my watch by this phenomenon. “Oh. The shakes. It must be 11 o’clock.” Then I might eat a sweet bar and really feel superb for the remainder of the day.

Why does this occur?

Insulin secretion is biphasic. When a nondiabetic eats a carbohydrate meals, the pancreas shortly spurts out a pulse of insulin. This pulse does not final very lengthy nevertheless it’s sufficient to maintain the  carbohydrate that reaches the gut from going very excessive. It additionally suppresses the manufacturing and launch of glucose from the liver. This is named the section 1 or first section insulin response.

Then insulin is secreted constantly so long as carbohydrate comes into the system in proportion to the quantity of carbohydrate reaching the gut. This is the section 2 or second section insulin response, and it lasts for much longer than the primary one.

The meals that we eat, together with carbohydrate, is not dumped into the gut . Instead, the abdomen releases solely a certain quantity at a time, normally containing about the identical variety of energy, so the insulin launch is fairly regular. Liquids depart the abdomen quicker than solids.

Unfortunately, these of us with kind 2 diabetes are inclined to lack a first section insulin response and should have lacked it for a very long time earlier than we have been recognized with diabetes. This implies that after we eat carbohydrate, our BGs aren’t knocked down by that first insulin pulse, in order that they go a lot larger than they’d in a nondiabetic who ate the identical quantity of carbohydrate. Then the physique sees these excessive numbers and assumes they’re that top regardless of a first section insulin response. So the second section response is additional sturdy, and with all that additional insulin, we might go low. Some individuals name this “too much too late.”

Now, nobody actually is aware of at what level in our life the primary section insulin response is eradicated, though there may be proof that first-degree family of individuals with diabetes have impaired first-phase insulin responses regardless of having regular BG ranges.  We additionally do not know if or when the primary section is restored when individuals normalize BGs sufficient to be thought of nondiabetic once more.

I used to be in a scientific examine through which they did an intravenous glucose tolerance take a look at that measured each BG and insulin after a big dose of glucose. I began with virtually no section 1 response. But after I used to be on the examine drug (salsalate) for a couple of weeks, the section 1 response was restored to about 70% of regular, which is in keeping with the concept that the state of affairs is reversible.

Weight loss alone might or might not restore the section 1 response, however there’s some proof that section 1 is restored after weight-loss surgical procedure.

So should you’ve reversed your diabetes in order that your BG ranges are in regular ranges, you should still lack that section 1 response and be delicate sufficient to giant carbohydrate masses that you will have reactive hypoglycemia.

That occurred to Joseph just lately. He had misplaced a lot of weight after gastric bypass surgical procedure, and his BG ranges have been normally regular, however he nonetheless watched his weight loss program and did not go overboard with the starches. Then at some point he was at a soccer sport, and it was very chilly and his associates had a lot of tasty crackers with them, so he ate some. No, he ate a lot. A number of hours later, he felt odd and examined his BG. It was 35. Luckily, he wasn’t alone, and somebody gave him some juice and he recovered.

I do not know how low I used to be after I labored the wire desk and received the shakes after consuming a doughnut with black espresso. But I do comprehend it was very disagreeable. So should you’re a recovered diabetic, be vigilant and do not let this occur to you. Avoid carbohydrate fests, particularly on an empty abdomen. And if you cannot keep away from them, be sure you have accessible some glucose tablets or different meals that can elevate BG shortly in case you do go low.

Reactive hypoglycemia is counterintuitive (“How could I be low when I just ate all those carbs?”), however it may be critical. You can outsmart it, although, should you’re ready.